So far there has been little effort to seek out this wisdom. Understandably, the tribes that have been directly impacted by poor care were invited to the Congressional hearings to describe their experiences and give their recommendations. Those are vital but we should learn from the places doing Indian health right as well as from those tribes that have suffered from where it has been done badly.

Congress should establish a commission with leading experts on Indian health care from the self-governance tribes and task it with providing advice from their experience. How do they recruit and retain providers? How do they infuse their care with tribal culture and practices? How do they deal with doctors who are not doing quality work? How do they use technology to bring care to rural communities? What are the best ways to incorporate an understanding of historical trauma into the provision of health care? The list of key questions is long and requires an in-depth exploration to address.

The tribes running their own facilities have extensive experience facing up to the same challenges that the direct service hospitals and clinics have – it’s time to learn from them how to remake IHS so that it provides more of the quality care its patients deserve.